Context

Management of osteoarthritis (OA) in primary care is often pharmacologically dominated with paracetamol and oral non-steroidal anti-inflammatory drugs (NSAIDs) both very commonly used.1 Current evidence-based guidelines recommend both agents, starting with paracetamol. This is because NSAIDs have a serious side effect profile and paracetamol is generally a lot safer (though perhaps not without problems).2 However, while NSAIDs have been demonstrated to be arguably the most efficacious drugs for OA across multiple trials, recent systematic literature reviews of the much smaller paracetamol literature have suggested it has …